<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="hkj/set">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('医院')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-hospital" class="form-control" disabled name="row[hospital]" type="text" value="{$hospital.name}">
        </div>
    </div>
    <input type="hidden" name="row[hos_id]" value="{$hos_id}">
    <input type="hidden" name="row[off_id]" value="{$off_id}">
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('科室')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" disabled name="row[name]" type="text" value="{$row.type_name}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('病症')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-office" data-rule="required" data-field="name" data-source="cyclopedia/disease/index" class="form-control selectpage" data-multiple="true"  name="row[disease_id]" data-primary-key="disease_id" data-max-select-limit="1000000" type="text" value="{$des}">
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
